Healthcare Provider Details

I. General information

NPI: 1740105071
Provider Name (Legal Business Name): NEU HAVEN MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 N RIDGEWOOD AVE
EDGEWATER FL
32132-1662
US

IV. Provider business mailing address

409 N RIDGEWOOD AVE
EDGEWATER FL
32132-1662
US

V. Phone/Fax

Practice location:
  • Phone: 619-787-1346
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ERICA NEUBERT
Title or Position: PRESIDENT
Credential: DNP, APRN
Phone: 619-787-1346